Individual
MELISSA GALE PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3531 WOODRIDGE BLVD, 11, FAIRFIELD, OH 45014-8545
(513) 969-5726
Mailing address
3531 WOODRIDGE BLVD, 11, FAIRFIELD, OH 45014-8545
(513) 969-5726
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
PN-124453-M-IV
OH
Other
Enumeration date
05/05/2011
Last updated
05/05/2011
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